The Rezum procedure and BPH

Technically, the Rezum (name brand) is a new variation of a Transurethral Needle Ablation procedure (TUNA).

Prostiva (brand name) is an older type of TUNA, which came about in 1997; it has very limited use today, and we have not performed this in some time.  Results lasted, in general, 3-7 years; on the flip side, side effects were generally minimal, and in many cases, a foley catheter could be avoided, so the right patients were pleased with it.

Hi,

Are there three generations of this type of procedure -- Prostiva, TUNA and Rezum or just two generations -- TUNA and Rezum. Thanks.

Jim

Hello  Maybe you can answer this.  Do you still do TUNA procedure.  I just got done reading a article from the medical news.  About a 5 year trial.  It was 121 men  turp or tuna   Tuna had very little problems where the turp had a 41% of men with retro.  Why don't they stop doing the turp there are do many problems..Ken   I have alot more to say but having problems with my computer  Ken

There are at least 4 generations of old style TUNA; from my recollection, the "Prostiva" is the only one currently available from this older class, I believe. The Rezum is the "newest" version, but different in a lot of ways when it comes to the engineering aspects.

We do a lot of "TUNA", but mainly using Rezum. The older style, "Prostiva" we do occasionally for men with minimal symptoms.

Most/almost all men who have TURP will have ejaculation issues afterwards; for men who consider this a priority, I counsel against this treatment; however, it is still probably the best option for men who have severe symptoms or urinary retention.

I have read a few articles on TUNA and iseam like they have very little side effects and no mention of retro.  But with Rezum there is no way of stopping retro because you have no control of the steam.The steam does not know prostate tisuee from the ducts.  the only way to stopthat  is to have it done on the right side only.  Ken  

Actually, an experienced urologist can control where the steam is applied, and ejaculation and sexual side effects should be minimal. See, Erectile and Ejaculatory Function Preserved With Convective Water Vapor Energy Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Randomized Controlled Study by McVary, et al; 136 patients were treated with Rezum vs 61 control;  ejaculatory function was no different between the treatment group and the control group. Rezum has been a fantastic procedure for men who wish to preseve this function.

Thank you  I will read it and let you know what I think   Ken

Good morning.  I read the article that you said and did so many times.  I wish they would talk english. But what I get from that is that it is a good procedure but alot is said about the sexual function is perserved.  But doctor to not consider the male ejaculation a sexual function.  The pumping action is still there after any procedure so you get the feel but a no show   Next

I also read a article on the Rezum Procedure that was done in San Diego.  It provides durable symptom improvement while preserving sexual functions.  Very vague.  It did say it had a problem with a decrease in ejaculatory volume. And also a small problem with anejaculation    Next

In Conclusion....The Rezum Procedure seam like a good option ( No cutting ) But even with the small risk I would not do it unless it is ajusted to the way i want it done not the way the doctor wants to do it..  If for some reason I could not have the Urolift done again.  I would only have it done on the right side.  I'm keeping what I got.  Take care and thank you for coming on our site and helping answer questions.  Ken 

Sorry I had to do it this way  Having problems with my computer   Have a good week to all of you all.  PS to all that knows no surgery for my daughter for right now have to have another MRI

Actually, they explicitly refer to ejaculatory function, and state it is unchanged compared to the control group; looks like in the preliminary studies, ejaculation is maintained!

@JerseyUrologyGR: (They) state (ejaculatory function) s  unchanged compared to the control group; looks like in the preliminary studies, ejaculation is maintained! 

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From the Rezum website Physician Q&A: 

"We saw no clinically significant change in erectile or ejaculatory function. There was a low occurrence rate of decreased ejaculatory volume (9 subjects, 4.8%) and anejaculation (6 subjects, 3.2%)."

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How do you reconcile this with the fact that here on this website retro ejaculation as side effect of Rezum was reported over 10% of the time, and you stated that in your own practice that retro ejacuation was "over zero" and that you would not recommend it to anyone where preserving ejaculatory function is important.

I think your statement in that regard is responsible, but Ken's point, and a lot of our concerns here is that the data and information that Rezum is putting out is not the same as what some people are experiencing.

Jim

 

On second read, they do state that six subjects (3.2%) did experience "anejaculation" which given their previous statement "no clinically significant change in erectile or ejaculatory function" does seem to minimize what most men call ejaculation, again as Kenneth suggested, which is antegrade ejaculation where the semen comes out of the penis. My understanding of "anejaculation" is that it compromises both retro ejaculation and no ejaculation at all. 

Jim 

It is very confusing.  You are told that the ejaculation will be saved you have the procedure and after a few week you try it.  You have less volume but you still have it.  Another 2 week and it gone.  What give.  I went to my urologist today and all is good but I did find out that they are not going to do the Rezum at his practice.  All I could find out was they said that there were to many problems.  And men were not going for it..Have agreat day   Ken 

As my boss always used to tell me, "the plural of anecdote isn't data".

You have to be careful what you see on a website forum; 

there is undoubtedly a cognitive bias of those who post; it wouldn't be a scientific study to just look at posts, add up people who complain, and report that as "science". 

I am very careful to detail EVERY possible risk that can entail from any procedure- just having anesthesia for something simple, for instance, has the risk of death.

That being said, anything that you use to treat the prostate has the possibility of causing changes in the ejaculation function, as the prostate serves to store and transmit ejaculation.

kenneth- there has actually not been a lot of reported issues- I wonder if they may have been confusing it with a different practice, or if perhaps the company wouldn't allow them to offer it at this time.

I don't believe that rate was any higher than the control group (or at least wasn't statistically higher.)

I don't know.  They were offering it but men were not taking it.  The nurse that I talk to Told me that they did not want to take the risk on retro even if is a slim chance.  The men range from 50 to 65.  I also found out that my doctor and is partner are doing 10 to 15 UROLIFT a week.  Hey Jim. I guess mena re researching there treatments more.  Also my doctor told me thank you a few of the men that I have talk to on this site have come and seen him.  They told him they have learned alot from this site.  Talk late going out  Ken 

Strange; that has been different than our experience; we have the busiest Urolift surgeon in the country. They both have their place in treatment. A lot of it has to do what insurance pays for

@JerseyUrologyGr: "As my boss always used to tell me, "the plural of anecdote isn't data".

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My ex girlfriend used to tell me that "you can't cherry pick an argument"

As to retro and Rezum, in addition to the the anecdotal data here was Rezum's own study data which showed 3.2% anejaculation. And probably more germand, you stated a few days ago that your own incidence of retro was "more than zero" and you would therefore not recommend Rezum to anyone where retro was an issue. 

Jim

 

I don't recommend anything to anyone who would "rather die than have ejaculation issues"; fortunately, those patients are few and far between in my practice. Rezum seems to be safer than just about anything for preserving ejaculation. 

In that study, 3.2% was not a statistically significant difference vs. the control group.

I don't remember anything about "dying" in your previous posts. I think you said something to the effect that if retro was an issue you would then offer Urlolift. 

As to the 3.2% anejaculation, while I don't have access to the full text version, the study stated that the control group had " Rigid cystoscopy with simulated active treatment".

Unless I'm missing something, I do not see how it's possible that 3.2% of men come out of a rigid cystoscopy with anejaculation.

Jim

They likely had ejaculatory issues as a baseline.

Many men with large prostates have ejaculation issues without treatment; if the disease progresses, they can likely worsen. 

You're not missing something, but this is the nature of randomized case-controlled research; many in the control group will think something has changed, as well.

Without debating that point, I think we're both in agreement that there are other treatments -- Urololift is the example you gave-- where retro should be less of a concern than Rezum. Also, if you can, could you either post here or Private Message me a link to the full text study -- or at least a citation -- where it states that the control group experienced 3.2% anejaculation or similar. 

Related, you mentioned you came here to help men with questions and problems related to FDA approved, insurance reimbursed, procedures for BPH. And again, I think overall your presence here is much appreciated. 

However, I do hope that you will also view this as a learning experience on your end.

I am not going to be so presumptious to say that anyone here can teach you anything about urology, but I think you might at least learn a little about how patients feel about some of these issues, for instance retro ejaculation,  in a protected and candid environment like on this forum.

For various reasons, including time constraints, trying to assimilate new data on the fly, and "white coat" intimidation, and sometimes no other medical options -- patients sitting across from their doctor may present a different picture then in a candid and reflective environment like here. 

Jim

James, you have been studying all the methods but are evidently unconvinced as you still prefer to self cath.

What is the Jersey Urology view of that as a long term method of avoiding the clutches of urologists.

It is a wonderful option to have.

I have plenty of patients who use it, particularly when the bladder doesn't work well or they are not a candidate for a procedure.

If performed correctly, it can be a great long-term solution as well.

Theoretically, Urolift should have a lower rate of ejaculatory side effects than any ablative technique; however, as the architecture of the bladder neck is still altered during this (or, really, ANY treatment), I would never say the risk is absolutely zero.

The study I posted earlier claimed the risk of ejaculation issues were not statistically different than the control group; I'd like to see a study with a larger N, of course, but at least this procedure has some science behind it.

Hi Derek,

Yes, I think that about summarizes my stance both three years ago when I started to self cath, when it was pretty much just TURP and GL, and even today. The difference is that today I see more promise in a few newer procedures like FLA and  now Aquablation, but I think it's too early for me to try either, should I need to. But that's just me, Derek, as my requirements and risk/reward criteria may be different from yours and others.

As to the self cathing, it allowed me to extend my watchful waiting period so I would have the luxury of still waiting for a procedure that does meet my requirements, and I do suggest this option to others who have similar thinking.

Jim

 

I only have access to the abstract that doesn't make this clear, not was the incidence of antegrade ejaculation qualified on Rezum's Physician's Q&A.

I also saw a study review on researchgate which stated: "...The Rezum System appears to have minimal to no negative impact on erectile function. However, further, well designed longer term studies are required to confirm these preliminary findings" 

I'm sure Rezum makes sense for many men willing to take a small but real risk of retro ejaculation, but personally I would wait for all the reasons I've mentioned before. 

Jim

Do you have a source? Likely most studies will have such a disclaimer until their N>10,000 or so;

That being said, the studies from the past year, particularly Roehrborn's and McVary's, demonstrate safety, efficacy, and minimal side effects, with an N>300.

That was the wrong quote from researchgate...

Should have been: " There were no cases of de novo erectile

dysfunction. However, its impact on ejaculatory function was not clear"

Not sure if this was referring to the study you cited or the first study, but again I don't have full text access. 

Jim 

 

No, that would be a different study. 

"Ejaculatory bother score improved 31% over baseline (P = .0011)?" (p of less than 0.05 generally indicated statistical significance.)

Hey Jim..  I read the same thing a few times and it made no cents to me.  Well when you get down to it.  There are men that will not give it up and men that really don't care.  It is up to the person to pick the treatment that they are going to have. But in doing this doctors sjould make sure you have all the test to make sure what the problem is.  If you have trouble with you bladder why should you have your prostate out????  Same with bladder cancer they tell you that you have to have your bladder out but when they do that you have to also take a healthty prostate out.  Also the seminal vessel why.  The only reason they do that is that in 5 or 10 years you may get cancer.  To me that makes no cents.  They tell you that you may have a heart attack to.  do they say like take it out because you may have a heart attack in 5 or 10 year.  That may sound dumb.  Be a man has a right to have any treatment he wishes.  I have talk with my doctor and he said if the patient does not want to do that he wont.   Let keep getting all the information you can  Ken  

Where does that say anything about that in the videos or in the text for the urolift.  Ask far has i have read and watch many of the video they do nothing to the bladder neck just goes into the bladder and reloads.  Somthing is not right He        Ken

I don't 100% understand the question.

Urolift suture placement opens up the prostate, opening up the obstructed portion (including the tissue by the bladder neck); this has a theoretical risk of changing ejaculation, but significantly less than an ablative procedure.

I know that they open up the prostate and I guess it moves the bladder neck but they do not touch or cut at it like the others so you should not have a problem with retro they do not damage it in any way   Ken

As I've said, the chances are much less than with an ablative technique, but nothing in medicine is 100%; anything which changes the prostate architecture has the theoretical risk of changing your ejaculation. 

@JerseyUrologyGr: t is a wonderful option to have.I have plenty of patients who use it, particularly when the bladder doesn't work well or they are not a candidate for a procedure. If performed correctly, it can be a great long-term solution as well.

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I am glad to see you view CIC as a good option. To expand on what you said, CIC can also be useful for bladder rehabilitation either prior to or after a prostate reduction procedure, or even in lieu of it as in my case; (2) A strategy to extend watchful wating period either for the patient who doesn't see anything currently to their liking, or is looking around the corner at promising new, but still unproven procedures.

Jim